The ShiftShapers Podcast

EP #414: Advisors as Fiduciaries? — With Nathan Gabhardt

July 25, 2022 David Saltzman
The ShiftShapers Podcast
EP #414: Advisors as Fiduciaries? — With Nathan Gabhardt
Show Notes

The focus of this week's episode is the pharmaceutical supply chain as TrueScripts founder Nathan Gabhardt discusses the role of Pharmacy Benefit Managers in drug spending, in particular how they make money, and how employers can guard against irrational expenditures.

What You’ll Learn From This Episode:

  • 1:48 Nathan’s background, passion for pharmacy, and desire to help others.
  • 2:59 Defining “fiduciary” and the problems associated with it.
  • 4:01 How the pharmaceutical supply chain work.
  • 7:04 What happens if PBMs are taken out of the supply chain.
  • 11:35 The pharmaceutical industry’s complexity and confusion.
  • 17:26 What can you do as an employer to safeguard your plan from fraud and extravagant spending?
  • 19:25 How medical professionals pick the drugs they give their patients.


3:28 “What I think a fiduciary is, is that you cannot make decisions based off your own financial well-being but it’s got to be the financial well-being of the consumer.”

3:39 “The problem is, is in the pharmacy space PBMs, which are pharmacy benefit managers, they sit in the middle of virtually every transaction of every prescription that gets filled, a PBM is involved with 90 plus percent of all those, and PBMs are not considered fiduciary agents. So ultimately, that’s where the problem lies.”

6:50 “From my experience, as a retail pharmacist, if a drug is not covered, the member typically doesn’t just pull out their wallet and pay $500 or $600, they have us call the prescriber and ask what is covered.”

7:27 “I am traditionally an anti-PBM. PBMs have caused a lot of harm to the profession of pharmacy, they really have and they cause a lot of harm to employers. However, if we remove that entire system, from our industry, our industry would collapse in my opinion.”

12:22 “Particularly in the PBM industry, our industry defies the laws of mathematics. And what I mean by that is that a higher discount does not necessarily mean that your net cost is going to be lower.”

17:36 “Follow the money. Anyone you have working around the table on your behalf, ask them how are they generating their revenue, every penny that’s generated off your account, you need to know that.”